340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART 10-5441
CAH171319-00 Rural Health Resources of Jackson County, Inc. d/b/a Holton Community Hospital
Print
Covered Entity Details
Entity Name
Rural Health Resources of Jackson County, Inc. d/b/a Holton Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171319-00
Entity Address
1110 Columbine Dr.
Holton, KS 66436
Medicare Provider Number
171319
Participating Start Date
10/1/2012
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WAL-MART 10-5441
Pharmacy Address
2600 NW ROCHESTER RD
TOPEKA, KS 66617
Pharmacy Comments
Contract Details
Approval Date
7/14/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2017
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Carrie Lutz, CEO
(785) 364-9645
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/14/2015
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session